Page 3 - Cardiac testing for coronary artery disease in potential kidney transplant recipients

[Diagnostic Test Accuracy Review]
Cardiac testing for coronary artery disease in potential kidney
transplant recipients

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Louis W Wang 1,7 , Magid A Fahim , Andrew Hayen , Ruth L Mitchell , Laura Baines , Stephen Lord , Jonathan C Craig 4,7 , Angela
C Webster 4,7,8
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1 Department of Cardiology, St Vincent’s Hospital, Darlinghurst, Australia. Department of Nephrology, Princess Alexandra Hospital,
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Brisbane, Australia. Screening and Test Evaluation Program (STEP), Sydney School of Public Health, University of Sydney, Sydney,
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Australia. Cochrane Renal Group, Centre for Kidney Research, The Children’s Hospital at Westmead, Westmead, Australia. Renal
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Services, Newcastle upon Tyne Hospitals NHS, Newcastle upon Tyne, UK. Cardiology Services, Newcastle upon Tyne Hospitals
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NHS, Newcastle upon Tyne, UK. Sydney School of Public Health, University of Sydney, Sydney, Australia. Centre for Transplant
and Renal Research, Westmead Millennium Institute, University of Sydney at Westmead, Westmead, Australia
Contact address: Louis W Wang, louis.w.wang@gmail.com.
Editorial group: Cochrane Renal Group.
Publication status and date: New, published in Issue 12, 2011.
Review content assessed as up-to-date: 1 November 2010.
Citation: Wang LW, Fahim MA, Hayen A, Mitchell RL, Baines L, Lord S, Craig JC, Webster AC. Cardiac testing for coronary artery
disease in potential kidney transplant recipients. Cochrane Database of Systematic Reviews 2011, Issue 12. Art. No.: CD008691. DOI:
10.1002/14651858.CD008691.pub2.
Copyright © 2011 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

A B S T R A C T

Background
Patients with chronic kidney disease (CKD) are at increased risk of coronary artery disease (CAD) and adverse cardiac events. Screening
for CAD is therefore an important part of preoperative evaluation for kidney transplant candidates. There is significant interest in the
role of non-invasive cardiac investigations and their ability to identify patients at high risk of CAD.

Objectives
We investigated the accuracy of non-invasive cardiac screening tests compared with coronary angiography to detect CAD in patients
who are potential kidney transplant recipients.
Search methods
MEDLINE and EMBASE searches (inception to November 2010) were performed to identify studies that assessed the diagnostic
accuracy of non-invasive screening tests, using coronary angiography as the reference standard. We also conducted citation tracking via
Web of Science and handsearched reference lists of identified primary studies and review articles.
Selection criteria

We included in this review all diagnostic cross sectional, cohort and randomised studies of test accuracy that compared the results of
any cardiac test with coronary angiography (the reference standard) relating to patients considered as potential candidates for kidney
transplantation or kidney-pancreas transplantation at the time diagnostic tests were performed.
Data collection and analysis

We used a hierarchical modelling strategy to produce summary receiver operating characteristic (SROC) curves, and pooled estimates
of sensitivity and specificity. Sensitivity analyses to determine test accuracy were performed if only studies that had full verification or
applied a threshold of ≥ 70% stenosis on coronary angiography for the diagnosis of significant CAD were included.
Cardiac testing for coronary artery disease in potential kidney transplant recipients (Review) 1
Copyright © 2011 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.